Provider Demographics
NPI:1184602039
Name:FRAZE, RICHARD LAWRENCE (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LAWRENCE
Last Name:FRAZE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ROCKAWAY RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833-4408
Mailing Address - Country:US
Mailing Address - Phone:908-236-6495
Mailing Address - Fax:
Practice Address - Street 1:67 MOUNTAIN BLVD EXT
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5602
Practice Address - Country:US
Practice Address - Phone:732-560-8877
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI007006001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice